Genital herpes 2

Genital Herpes: Diagnosis and treatment

Diagnosis

Herpes can be detected by a viral culture of a lesion, if one is
present, or by a blood test. Some experts recommend both
methods.

With a viral culture, a doctor swabs a lesion to pick up cells,
puts the swab in a special solution, and sends it to a lab for
growing and analyzing.

Although a doctor may recognize a herpes lesion by examining it,
a viral culture will confirm the presence and type of HSV. Once
they know whether they have HSV-1 or HSV-2, people have a better
idea of how often they will have recurrences.

But viral cultures do have their drawbacks. If the lesion has
started to heal (usually 48 hours after its appearance), the swab
may not pick up enough virus and the culture result will be a
"false negative." (False positives in cultures are rare.)

A blood (serology) test can be used to confirm a negative
culture. It can also be used to diagnose herpes in a person who has
no symptoms, who has genital irritation but isn't sure it's herpes,
or who has a sexual partner with herpes and wants to find out if he
or she has already become infected.

"Diagnosing whether someone has herpes or not is quickly done by
a serology test because once you've become infected, an
immune-competent individual will develop antibodies to the herpes
that is infecting them," says Thomas Simms, a biologist in the
FDA's Center for Devices and Radiological Health.

Herpes antibodies will usually show up in the blood several
weeks after a person first becomes infected. Some blood tests can
determine the type of herpes infection, but cannot indicate whether
the herpes is oral or genital. So people without symptoms may not
know for certain if their herpes is oral or genital.

In the past several years, the FDA has cleared three blood tests
that accurately determine if a person is infected with HSV-1 or
HSV-2. The HerpeSelect ELISA Kits and the HerpeSelect Immunoblot
Kit made by Focus Technologies of Herndon, Va., detect both types.
The POCkit Rapid Test made by Diagnology Inc. of Cary, N.C.,
detects HSV-2 only.

Another blood test is the Western Blot. Although not 100 percent
accurate, the Western Blot is considered the "gold standard" of
blood tests and is used to determine the accuracy of other herpes
blood tests that are developed. The University of Washington is the
premier institution for performing and interpreting the test. (See
"For More Information" to find out how you can have your blood
tested with a Western Blot.)

Many older FDA-cleared blood tests for herpes are still on the
market, and many labs use these tests because they are widely
available and inexpensive. Although they may be labeled
type-specific (can determine whether the infection is HSV-1 or
HSV-2), they are not reliable, says Simms.

This is where a herpes support group can help. These groups
usually keep a list of doctors who are up to speed, knowledgeable,
and know what the right tests are.

Treatment

Although there is no cure for genital herpes, there are
medications that significantly reduce the frequency and duration of
outbreaks and have few side effects in most people.

In 1985, the FDA approved Zovirax (acyclovir), the first genital herpes drug,
which is now available in a generic form. More recently, the FDA
approved two other drugs to treat genital herpes: Famvir (famciclovir) and
Valtrex
(valacyclovir).

All three of these oral antiviral drugs can be taken either
episodically (when a person has an outbreak or feels one coming
on), or suppressively (daily, to help prevent the recurrence of
outbreaks). Acyclovir and valacyclovir are also FDA-approved to
treat an initial episode of genital herpes to help heal the lesions
and to lessen the pain.

When taken episodically at the first sign of a tingling or
itching sensation, an antiviral drug may prevent an outbreak
altogether. Once an outbreak occurs, if the treatment is started
soon enough, the drugs can lessen the severity and shorten the
healing time. When taken suppressively, the drugs don't always
prevent outbreaks, but help them to occur less frequently.

The antiviral drugs work by interfering with DNA synthesis to
prevent the virus from reproducing. Famciclovir and valacyclovir,
which are better absorbed by the body, can be taken less often than
acyclovir.

For more information:

National Herpes Resource Center, a service of the American
Social Health Association:www.ashastd.org/hrc

If you wish to be tested with the most accurate blood test for
detecting herpes, the Western Blot, have your health care provider
call 206-598-6066 to request the HSV type-specific serology
information packet.

Patient Assistance Programs to help low-income people buy
herpes drugs:

Novartis (maker of Famvir):1-800-277-2254

GlaxoSmithKline (maker of Valtrex and Zovirax):1-800-722-9294

Source: FDA ConsumerNews magazine (adapted from the American
Social Health Association).

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